Trunkline payer call

A medical practice's billing office spends its day on hold with health plans asking four questions: what happened to this claim, why was it denied, where is this authorization, and is this patient covered. This skill compiles one of those questions into a CALL-E call task and checks the answer that comes back.

Two rules make it different from a general "call and ask" skill, and both are enforced before and after the call rather than requested in the prompt:

1. Minimum necessary. Each workflow declares the only patient identifiers it may disclose. Eligibility gets a member id and a date of birth. It does not get a name, because it does not need one.
2. No answer without evidence. Every field comes back with the representative's own words. If that quote is not in the transcript, the field becomes unknown and a person looks at it.

When to use

Use this skill when a provider's billing office needs an administrative answer from a payer about a claim it has already submitted, and the answer is only available by phone.

When not to use

Do not use this skill to call a patient, to file or withdraw an appeal, to agree to any amount or adjustment, to discuss clinical care, or to place a live call without explicit approval and a written authorization for that destination. Trunkline gathers and structures; people decide.

Workflow

1. Choose the workflow. One of claim_status, denial_reason, prior_auth_status, eligibility. Read references/schemas.md for the closed result schema each one returns.
2. Assemble the request. Practice NPI, payer name and E.164 number, and one entry per claim: claim number, date of service, and a patient object holding that patient's identifiers.
3. Build the plan and read it. Run the preview below. It applies the disclosure envelope, drops every field the workflow may not disclose, and prints the exact task text and schema. It places no call.
4. Confirm intent. Show the operator the masked destination, the claims, and which identifier field names will be disclosed. Get explicit approval before dialling.
5. Place the call with run_call, or POST /v1/calls with the printed task and result_schema and an Idempotency-Key.
6. Check the answer with the check command. It validates the result against the schema locally and confirms every evidence_quote appears in the transcript. Anything it cannot confirm is reset to unknown.
7. Scrub before storing. Remove the patient identifiers from the transcript before it is written anywhere. Do not store a raw payer transcript.

Read references/safety.md before any live call. Read references/payer-playbook.md for phone-menu, hold, and transfer handling. Read references/examples.md for a worked request, task, and checked result.

Preview and check, with no call placed

python3 scripts/build_call_plan.py preview --request references/example_request.json
python3 scripts/build_call_plan.py check --request references/example_request.json --result references/example_result.json

preview prints the task text, the closed result schema, and the field names it disclosed. calls_placed is always 0 on this path. check reports each claim as grounded or reset.

Disclosure envelopes

Workflow	May disclose
claim_status	member id, date of birth, patient last name
denial_reason	member id, date of birth, patient last name
prior_auth_status	member id, date of birth, patient last name
eligibility	member id, date of birth

Never disclosed by any workflow: Social Security numbers or fragments, medical record numbers, home addresses, patient phone numbers, patient email. If a representative will not proceed without one, record what the billing office must supply and end the call.

What the agent may never do on the call

• Open by stating it is an AI assistant calling for the provider's billing office, and say so again whenever asked.
• State that the call may be recorded before asking anything.
• Never file, withdraw, or escalate an appeal, reconsideration, grievance, or peer-to-peer review.
• Never accept, waive, negotiate, or dispute any amount, adjustment, refund, offset, or recoupment.
• Never agree to a corrected claim, a resubmission, or any change to a claim.
• Never give a Social Security number, full address, medical record number, card, or password.
• Never discuss diagnosis, treatment, or clinical care.
• Never guess. A value not clearly stated is unknown.
• Always ask for a call reference number and the representative's first name before ending.

Safety

• Phone calls are real-world side effects. Require explicit user intent before any live call.
• Call published payer provider-services lines only. This skill never calls patients.
• Use E.164 numbers only, and mask them in every summary: +12*******42.
• Do not expose credentials. The CALL-E key belongs in the environment and goes only to the official API origin.
• Do not create hidden recurring schedules or duplicate jobs for the same claim. Send an Idempotency-Key and do not re-run a call whose result you have not yet read.
• Cancel by withholding approval or deleting the authorization for that payer. This skill never places a call on its own.
• Stay inside claim administration. Refuse medical, legal, financial, and emergency content.

Related

A full runnable implementation, with bundling, hold accounting, a review console, a hash-chained audit log, and 102 offline tests, is at apps/python/trunkline.